We have argued in this blog about the potential importance of
local population
health “policy packages” tailored to the specific health outcomes, factors,
and policy resources and climate of individual jurisdictions. Macinko and
Silver go beyond speculation with a compelling and important analysis of how
states have varied over time with regard to public health policy. They approach
this through the lens of two policy constructs: intradomain, which is the extent to which a state
adopts the entire set of evidence based policies for a given policy set such as
motor vehicle crashes, and interdomain referring to the extent
a state adopts evidence based policies across multiple domains such as smoking,
alcohol, and nutrition policies. Twenty-seven proven policies were examined,
such as seatbelt laws, indoor smoking bans, and firearm restrictions, to uncover
patterns within state policy environments between 1980 and 2000. One
of the figures in their paper demonstrates some interesting patterns,
including clustering of certain states into a few highly similar trajectory
groupings which basically negates the typical red/blue state patterns in terms
of health policy. The authors contend “these illustrations of state policy
behavior, albeit crude, nevertheless suggest there may be patterns of state
policymaking that bear further investigation.” This conceptualization and
tracking of state policy patterns is a fresh and important perspective that
should help us move forward with advancing a balanced investment portfolio of health in
all policies.

“How can society prevent the most disease and deaths per dollar
spent?” This is the opening line of this article, which evaluates 2815
cost-effectiveness analyses from the Tufts Medical Center Cost-Effectiveness
Registry. These reports were categorized by person-directed (e.g., smoking cessation
support) and environmental preventive strategies (e.g., indoor smoking ban);
also noted was whether interventions were provided in clinical or nonclinical
settings. Authors hypothesized that environmental measures would be generally
more cost-effective, and further hypothesized that nonclinical person-directed
initiatives would be more cost-effective than clinical ones, based on dollars
per Quality Adjusted Life Year (QALY). Findings reveal that a greater
proportion of environmental prevention strategies led to cost saving (46%) compared
to either clinical (16%) or non-clinical person-directed interventions (13%). In
addition, 25% of the environmental interventions were modestly priced (between
$10,000 to $50,000 per QALY), while another 17% were very low-cost (at less
than $10,000 per QALY). The authors conclude by noting that “even if the effect
of an altered environment on each person is small, the cumulative population
effect can be large; cost-effectiveness can be favorable because the cost per person
reached is small.”

Journals we follow:

American Journal of Preventive Medicine

American Journal of Public Health

Annual Review of Public Health

Health Affairs

Journal of the American Medical Association (JAMA)

Journal of Epidemiology and Community Health

Journal of Health and Social Behavior

Milbank Quarterly

New England Journal of Medicine

Preventing Chronic Disease

Social Science and Medicine

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.